atcn 2013 faculty update (july 23)

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Faculty Update2013

Objectives◦ Overview of critical content revisions 9th Ed. ATLS◦ Review ATCN 2013 edition Student Manual Skill Station Revisions Faculty Manual Triage Scenarios Initial Assessment Scenarios Written Exams◦ ATCN P&P Updates

ATCN 2013 Faculty Update


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9th Ed. ATLS Student Course All faculty need to have access to new ATLS

text. There are many updates and revisions

throughout all chapters. Faculty should re-read the ATLS text to

become familiar with the many updates. Faculty should attend their skill station

ATLS lecture. ◦ Yes, even if you have been teaching for years…

the ATLS slides have changed and the content that is taught/emphasized may be different.



Major ATLS Content Updates Initial Assessment◦ In many centers, trauma patients are assessed by a

team, the size and composition of which varies from institution to institution. In order to perform effectively, one team member should assume the role of team leader. The team leader supervises the preparation for the patient’s arrival, the assessment, treatment and transfer of the patient.



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Major ATLS Content Updates Airway◦ Previous concerns about cuffed endotracheal tubes

causing tracheal necrosis are no longer relevant due to improvements in the design of the cuffs. Ideally, cuff pressure should be measured as soon as it is feasible and, 30mm Hg is considered safe.

◦ Alternative intubation devices have been developed over the years with the integration of video and optic imaging techniques. Their use in trauma patients may be beneficial in specific cases by experienced providers. Careful assessment of the situation, equipment, and personnel available is mandatory, and rescue plans must be available.

ATCN 2013Faculty Update


Major ATLS Content Updates Shock◦ Hypertonic saline has no benefit over standard

crystalloid resuscitation.

◦ The concept of balanced resuscitation is further emphasized, and the term aggressive resuscitation has been eliminated. The standard use of 2 liters of crystalloid resuscitation as the starting point for all resuscitation has been modified to initiation of 1 liter of crystalloid. Early use of blood and blood products for patients in shock is also emphasized, without mandating or suggesting any specific ratio of plasma and platelets



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Major ATLS Content Updates’ Abdomen/Pelvis◦ Reemphasized title Abdomen and Pelvis to

delineate pelvis as under-recognized source of hemorrhagic shock.

◦ All pelvic content moved to Abdomen and Pelvis chapter



Major ATLS Content Updates Pediatric◦ Previous concerns about cuffed endotracheal tubes

causing tracheal necrosis are no longer relevant due to improvements in the design of the cuffs. Ideally, cuff pressure should be measured as soon as it is feasible and ,30mm Hg is considered safe.



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Major ATLS Content Updates Optional skills for ATLS students◦ DPL◦ Pericardiocentesis



2013 Student Manual Revisions 6 Skill station workgroups reviewed content and recommended

revisions International focus, > 40 faculty from 8 Countries and the US

ATCN Student & Faculty Manual Format Revisions.◦ References are only listed if not listed as a reference in ATLS text.◦ Selected terms and abbreviations updated for international consistency. ◦ Double side page printing, two color.◦ New outline format for all text.◦ New “Side Bar” Student Manual

Cautions: highlight situations/issues that may lead to patient harm Notes: additional information to supplement the main text

Faculty Manual Faculty Pearl: Highlights an opportunity to facilitate a discussion or emphasis an

idea Note: additional information to supplement the main text



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New Cover

Graphics!



New Layout and Format for Student &

Faculty Manuals


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ATCN Skill Station Updates Updated table top information cards Equipment lists updated ◦ Airway Surgical airway tray or representation of this

(optional)◦ Head Helmet optional◦ Musculoskeletal Long backboard deleted. Tourniquets added



Initial Assessment◦ - Delete Intubating LMA◦ + Add Tongue Blades

Airway◦ + Add End tidal CO2 device (optional)◦ + Add Surgical Airway tray (optional)

Shock◦ No changes

Head◦ - Delete Helmet (optional)

Musculoskeletal◦ - Delete Long backboard◦ + Add Pelvic Stabilizing Device / Sheet◦ + Add Tourniquet

Pediatric◦ + Add Pediatric Chest Tubes◦ + Add Towel or Blanket

(Used to align head/body on backboard)


Equipment ChangesRemember:Write-on

Board for each station


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ATCN 2013Faculty Update Initial Assessment

Student Manual Faculty Manual

◦ No change to the general content or format

◦ Integration of increased emphasis on balanced resuscitation

◦ Emphasis on pericardial tamponade and tension pneumothorax identification.

◦ Standardized format for EMS report.

◦ Specific guidance to faculty on responses to students assessments

If student uses a LEMON assessment during airway, the LEMON parameters are provided for the faculty to give to the student.

◦ “Pearls” to remind faculty to emphasize selected discussion topics. (i.e. difference between Tension PTX and Cardiac Tamponade.)


ATCN 2013Faculty Update Airway



◦ Improved graphics (larger and clearer images)

◦ Selected lab values (i.e. PaCO2) identical to those referenced in the ATLS text.



If student uses a LEMON assessment during airway, the LEMON parameters are provided for the faculty to give to the student.

◦ “Pearls” to remind faculty to emphasize selected discussion topics. (i.e. importance of needle placement for treatment of tension PTX.)


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ATCN 2013Faculty Update Shock




◦ Emphasis on “balanced resuscitation”

◦ New sections on Non-hemorrhagic shock conditions (i.e. cardiac tamponade, neurogenic shock, etc.)


◦ Specific guidance to faculty on responses to students assessments Changes to vital signs during

scenario. **Faculty should use their judgment to give the student a clinically accurate picture based on the assessments and interventions selected by the student

◦ “Pearls” to remind faculty to emphasize selected discussion topics. (i.e. if the student asks for an ABG, discuss the relevance and importance of the results)


ATCN 2013Faculty Update Head


◦Helmet removal no longer taught as a skill.


◦ Helmet removal no longer a skill, however, faculty have the option to discuss principles of helmet removal as appropriate for each student class.

◦ “Pearls” to remind faculty to emphasize selected discussion topics. (i.e. if the student asks for an ABG, discuss the relevance and importance of the results)


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ATCN 2013Faculty Update Musculoskeletal


◦Securing patient to long spine board no longer taught as a skill. Application C-collar and principles of spinal immobilization (logrolling) are still taught.

◦ Increased emphasis on extremity neurovascular assessments.

◦Emphasis on skills for immobilization of fractured pelvis.

◦ Placing patient on, and securing to, a long spine board, is no longer taught.

◦ C-collar application and principles of logrolling are still taught.

◦ Case scenarios revised I- collar application and logrolling II-Neurogenic vs. spinal shock III-Pelvic fracture immobilization IV-Tourniquets, Compartment syndrome

◦ Note: Case II is a neurogenic shock scenario, NOT a spinal shock scenario. Faculty with early print editions should note this on pg. 60 of their faculty manual.

◦ Additional 4th case scenario will make time management especially important.

◦ Faculty need to review/learn proper hands on skills for pelvic immobilization based on the equipment use in their region.

◦ “Pearls” to remind faculty to emphasize selected discussion topics. ATCN 2013 Faculty Update

ATCN 2013Faculty Update Pediatric

Student Manual Faculty Manual◦ No change to the general content or

format.

◦ Use of cuffed ETT now taught.

◦ Use of Atropine during intubation is for patients 1 y/o or less.

◦ Expanded emphasis on airway assessment and interventions.

◦ Introduction of mnemonic DOPE for troubleshooting airway problems. Dislodgement Obstruction Pneumothorax Equipment failure



◦ “Pearls” to remind faculty to emphasize selected discussion topics.

◦ Note: ATLS text inconsistencies. Pg. 253, midazolam doses in

figure 10-3 differ from those referenced in text below, faculty should review reasons for this difference.

Pg. 256, calculation for weight listed as 2x age +10. ATCN table top card uses 2x age +8.


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Triage Scenario Review Triage Scenarios printed in ATLS student

manual. Combined ATLS/ATCN Triage Scenario review

is encouraged (and supported by the ACS!) If combined review is not possible◦ ATCN is permitted to use ATLS scenarios

independently Faculty answers, ATLS Faculty Manual (section 2,

appendix J)◦ New ATCN Triage Scenarios will be available for use

at the discretion of Course Director




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New ATCN Website! www.atcnnurses.org

General access pages for all faculty

Secure access pages for Course Directors◦ Written exams, Initial assessment scenarios.

Links to trauma educational resources.




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New written exam questions cross-reference with ATLS and ATCN texts. Available on Course Director web page


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Written exam question analysis tool


Initial Assessment Scenario analysis tool


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ATCN Policy & Procedures Update New Format New P&Ps◦ Live Video Conference Option◦ 1 day ATCN Refresher Course◦ Student Course options for APNs who have taken

ATLS





atcn 2013 faculty update (july 23)

Documents

faculty updateatcn

faculty update814201329th

faculty update2013 student

atls review atcn

atls slides

atls student course

new atls text

pelvic content